CLINICAL INVESTIGATION Tenon advancement and duplication technique to prevent postoperative Ahmed valve tube exposure in patients with refractory glaucoma Nevbahar Tamcelik • Ahmet Ozkok • Ahmet Murat Sarıcı • Eray Atalay • Huseyin Yetik • Kivanc Gungor Received: 16 August 2012 / Accepted: 18 March 2013 / Published online: 24 May 2013 Ó Japanese Ophthalmological Society 2013 Abstract Purpose To present and compare the long-term results of Dr. Tamcelik’s previously described technique of Tenon advancement and duplication with the conventional Ahmed glaucoma valve (AGV) implantation technique in patients with refractory glaucoma. Methods This study was a multicenter, retrospective case series that included 303 eyes of 276 patients with refractory glaucoma who underwent glaucoma valve implantation surgery. The patients were divided into three groups according to the surgical technique applied and the out- comes compared. In group 1, 96 eyes of 86 patients underwent AGV implant surgery without patch graft; in group 2, 78 eyes of 72 patients underwent AGV implant surgery with donor scleral patch; in group 3, 129 eyes of 118 patients underwent Ahmed valve implant surgery with ‘‘combined short scleral tunnel with Tenon advancement and duplication technique’’. The endpoint assessed was tube exposure through the conjunctiva. Results In group 1, conjunctival tube exposure was seen in 11 eyes (12.9 %) after a mean 9.2 ± 3.7 years of fol- low-up. In group 2, conjunctival tube exposure was seen in six eyes (2.2 %) after a mean 8.9 ± 3.3 years of follow-up. In group 3, there was no conjunctival exposure after a mean 7.8 ± 2.8 years of follow-up. The difference between the groups was statistically significant. (P = 0.0001, Chi-square test). Conclusion This novel surgical technique combining a short scleral tunnel with Tenon advancement and duplica- tion was found to be effective and safe to prevent con- junctival tube exposure after AGV implantation surgery in patients with refractory glaucoma. Keywords Tube exposure Á Ahmed glaucoma valve Á Glaucoma Á Glaucoma drainage implant Á Tenon advancement and duplication technique Introduction Glaucoma drainage implants are an important surgical modality to control intraocular pressure (IOP) in the man- agement of glaucoma patients who are refractory to more conventional treatments. These implants are designed to drain aqueous humor from the anterior chamber through a tube into a bleb overlying a plate that is located at the equatorial subconjunctival space. The aqueous humor filters through the bleb and is reabsorbed into the ocular and sys- temic circulation. By increasing the surface area of aqueous absorption, glaucoma drainage devices lower the IOP [1]. One significant postoperative complication of glaucoma implant surgery is exposure of the tube of the device fol- lowing erosion of the overlying conjunctiva. Ahmed glaucoma valve (AGV) tube exposure usually occurs 3–4 mm posterior to the limbus. This complication requires immediate treatment, as it may cause endophthalmitis, but unfortunately the treatment required is usually challenging [2–4]. In order to prevent tube exposure, the tube is N. Tamcelik Á A. Ozkok Á A. M. Sarıcı Á E. Atalay Á H. Yetik Ophthalmology Department, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey N. Tamcelik (&) Goz Hastaliklari Anabilim Dali, Cerrahpasa Tip Fakultesi, Istanbul Universitesi, Kocamustafapasa, Istanbul, Turkey e-mail: nevbahartamcelik@gmail.com K. Gungor Ophthalmology Department, Gaziantep School of Medicine, Gaziantep University, Gaziantep, Turkey 123 Jpn J Ophthalmol (2013) 57:359–364 DOI 10.1007/s10384-013-0249-5